J Korean Ophthalmol Soc.  2008 Jun;49(6):1022-1027. 10.3341/jkos.2008.49.6.1022.

Suprachoroidal Hemorrhage During Pars Plana Vitrectomy Associated with Valsalva Maneuver

• Lim HW
• Ko BW
• Song Y
• Lee BR

• KMID: 2110887
• DOI: http://doi.org/10.3341/jkos.2008.49.6.1022

Abstract

PURPOSE: To report a suprachoroidal hemorrhage by Valsalva maneuver during vitrectomy under general anesthesia.
CASE SUMMARY
A healthy 26-year-old man had vitrectomy under general anesthesia due to rhegmatogenous retinal detachment in his right eye. During scleral indentation and endolaser photocoagulation, he took a sudden and severe bucking reflex because the effect of general anesthesia was insufficient. After the bucking reflex, suprachoroidal hemorrhage occurred in his right eye. Immediate IOP elevation and hyperfluorocarbon tamponade was performed to remove the suprachoroidal hemorrhage and reattach the retina and choroid. The patient's corrected visual acuity was 20/50 and slender crescent shaped choroidal rupture remained around the temporal area of the macula, unlike traumatic choroidal rupture. Following fluorescein angiography, staining was evident at the choroidal rupture site; no fluorescein leakage was evident.
CONCLUSIONS
We report a case of acute suprachoroidal hemorrhage which we investigated by fundus examination and fluorescein angiography.

Keyword

Suprachoroidal hemorrhage; Valsalva maneuver; Vitrectomy

MeSH Terms

Adult
Anesthesia, General
Choroid
Eye
Fluorescein
Fluorescein Angiography
Hemorrhage
Humans
Light Coagulation
Reflex
Retina
Retinal Detachment
Rupture
Valsalva Maneuver
Visual Acuity
Vitrectomy
Fluorescein

Figure

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  Figure 1. Fundus photograph at the initial examination reveals simple rhegmatogenous retinal detachment in the superior quadrant.

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  Figure 2. After the bucking reflex, dark brown convex elevation representing suprachoroidal hemorrhage appeared during the surgery.

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  Figure 3. At postoperative 1 month, fundus photography showed slender choroidal rupture lines from the superior to inferior vascular arcade at the temporal area of the macula.

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  Figure 4. Fluorescein angiographs at postoperative 3 months shows fluorescein staining at the site of choroidal rupture. It seems to be traumatic choroidal rupture.

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  Figure 5. Indocyanine angiograph at postoperative 7 months shows features suggesting traumatic choroidal rupture.

Reference

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